Methicillin-resistant Staphylococcus aureus and Vancomycin Prescribing in the Emergency Department: A Single-center Study Assessing Antibiotic Prescribing.

IF 1.6 Q2 EMERGENCY MEDICINE
Joshua D Niforatos, Jeremiah S Hinson, Richard E Rothman, Sara E Cosgrove, Kate Dzintars, Eili Y Klein
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引用次数: 0

Abstract

Objectives: Given the support for methicillin-resistant Staphylococcus aureus (MRSA) antimicrobial stewardship in the 2021 Surviving Sepsis Campaign Guidelines, we sought to measure the use of vancomycin in the emergency department (ED) in the years preceding these recommendations.

Methods: A retrospective cohort study was conducted of all patients aged ≥ 18 years presenting to 5 emergency departments within a university-based health system who were given intravenous (IV) vancomycin during their ED index visit. The primary outcome assessed the proportion of patients with MRSA-positive blood cultures who received IV vancomycin in the ED. We also measured associations between clinical attributes associated with any MRSA infection.

Results: Of the 20,212 unique ED visits for patients who received IV vancomycin, 63% (n = 12,755) had at least 1 MRSA risk factor. Only 2.4% (n = 494) and 14.1% (n = 2850) of patients receiving IV vancomycin in the ED were found to have MRSA bacteremia or any MRSA-positive culture, respectively. A total of 3160 patients met Sepsis-3 criteria and received IV vancomycin, though 65% (n = 2064) had no MRSA risk factors. For any patient with culture-proven MRSA, 63.8% (n = 315) and 43.4% (n = 1236) received an MRSA antimicrobial in the ED. MRSA risk factors were not associated with MRSA bacteremia (≥1 MRSA risk factor: odds ratio, 1.3, 95% CI, 0.9-1.8) or an MRSA-positive culture of any type (odds ratio, 0.9, 95% CI, 0.7-1.1).

Conclusion: Within our hospital system, MRSA was an infrequent cause of bacteremia for patients presenting to the ED with sepsis or septic shock. Although vancomycin is frequently used in the ED, many patients with culture-proven MRSA did not receive MRSA antimicrobials. Notably, one-third of patients with culture-proven MRSA had no MRSA risk factors. MRSA risk factors were not predictive of culture-proven MRSA, thus highlighting the complexity of antimicrobial stewardship in the ED without validated clinical decision rules.

急诊科耐甲氧西林金黄色葡萄球菌和万古霉素处方:一项评估抗生素处方的单中心研究
考虑到2021年生存脓毒症运动指南中对耐甲氧西林金黄色葡萄球菌(MRSA)抗菌药物管理的支持,我们试图衡量在这些建议出台前几年急诊科(ED)使用万古霉素的情况。方法:一项回顾性队列研究对所有年龄≥18岁的患者进行了回顾性队列研究,这些患者在急诊科就诊期间接受静脉注射万古霉素。主要结果评估了在急诊科接受静脉万古霉素治疗的MRSA血培养阳性患者的比例。我们还测量了与任何MRSA感染相关的临床特征之间的关联。结果:在接受静脉万古霉素治疗的20,212例急诊患者中,63% (n = 12,755)至少有1个MRSA危险因素。在急诊科接受万古霉素静脉注射的患者中,分别只有2.4% (n = 494)和14.1% (n = 2850)发现MRSA菌血症或任何MRSA阳性培养物。共有3160例患者符合脓毒症-3标准并接受静脉万古霉素治疗,但65% (n = 2064)患者没有MRSA危险因素。对于任何经培养证实的MRSA患者,63.8% (n = 315)和43.4% (n = 1236)接受了MRSA抗菌药物治疗。MRSA危险因素与MRSA菌血症(MRSA危险因素≥1:优势比,1.3,95% CI, 0.9-1.8)或任何类型的MRSA阳性培养(优势比,0.9,95% CI, 0.7-1.1)无关。结论:在我们的医院系统中,MRSA是一种罕见的导致败血症或感染性休克患者出现菌血症的原因。虽然万古霉素经常用于急诊科,但许多经培养证实的MRSA患者并未接受MRSA抗菌剂。值得注意的是,三分之一经培养证实的MRSA患者没有MRSA危险因素。MRSA危险因素不能预测经培养证实的MRSA,因此,在没有经过验证的临床决策规则的情况下,突出了急诊科抗菌药物管理的复杂性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
4.10
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